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The Structural Clinical model: Disrupting oppression in clinical social work through an integrative practice approach


It is critical that clinical social workers become actively aware of the endemic processes and manifestations of racism, social inequities, structures and dynamics of white supremacy within and across organizational, supervisory and clinical relationships. The Structural-Clinical Model (SCM) is presented, providing a multi-layered and theoretically rich pathway for clinical social workers to examine the intricate, and multifaceted interconnections expressing racialized oppressive forces across macro, meso and micro systems that impact the totality of clinical practice. SCM integrates critical race theory, liberation psychology, and relational theories bridging long standing theoretical and conceptual divides. The SCM aims to de-pathologize clients, recognizing instead the pathology of white supremacy, racism, and other oppressive structural forces affecting organizations, relationships and people’s lives, particularly those most racially, ethnically and historically marginalized within our society. The SCM is introduced with a structural assessment framework designed to explore how structural social inequalities produced by white supremacy impact social work organizations, the clinical supervisory relationship and the supervisor-therapist-client relationship. A multilevel case example is provided to demonstrate how structural power dynamics that influence service delivery can be identified through critical dialogue using the SCM in the clinical supervisory relationship and between the clinical social worker and client.

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Correspondence to Peggy O’Neill.

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del Mar Fariña, M., O’Neill, P. The Structural Clinical model: Disrupting oppression in clinical social work through an integrative practice approach. Clin Soc Work J (2022).

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  • Clinical practice
  • Race
  • Structural assessment
  • Critical dialogue
  • Clinical social work supervision